Healthcare Provider Details

I. General information

NPI: 1710579545
Provider Name (Legal Business Name): MOBILE PHLEBOTOMY OF THE SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8611 FOREST GLEN AVE
BATON ROUGE LA
70812-4601
US

IV. Provider business mailing address

8611 FOREST GLEN AVE
BATON ROUGE LA
70812-4601
US

V. Phone/Fax

Practice location:
  • Phone: 225-384-6657
  • Fax: 866-628-9103
Mailing address:
  • Phone: 225-384-6657
  • Fax: 866-628-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: MARGO BROWN
Title or Position: OWNER
Credential: PJLEBOTOMIST
Phone: 225-384-6657